Preparation Room Research Articles

Outbreak of Burkholderia multivorans among patients at two acute-care hospitals in California, August 2021–July 2022

Background:Burkholderia multivorans are gram-negative bacteria typically found in water and soil. B. multivorans outbreaks among patients without cystic fibrosis have been associated with exposure to contaminated medical devices or nonsterile aqueous products. Acquisition can also occur from exposure to environmental reservoirs like sinks or other hospital water sources. We describe an outbreak of B. multivorans among hospitalized patients without cystic fibrosis at 2 hospitals within the same healthcare system in California (hospitals A and B) between August 2021 and July 2022. Methods: We defined confirmed case patients as patients without cystic fibrosis hospitalized at hospital A or hospital B between January 2020 to July 2022 with B. multivorans isolated from any body site matching the outbreak strain. We reviewed medical records to describe case patients and to identify common exposures. We evaluated infection control practices and interviewed staff to detect exposures to nonsterile water. Select samples from water, ice, drains, and sink splash zone surfaces were collected and cultured for B. multivorans in March 2022 and July 2022 from both hospitals. Common aqueous products used among case patients were tested for B. multivorans. Genetic relatedness between clinical and environmental samples was determined using random amplified polymorphic DNA (RAPD) and repetitive extragenic palindromic polymerase chain reaction (Rep-PCR). Results: We identified 23 confirmed case patients; 20 (87%) of these were identified at an intensive care unit (ICU) in hospital A. B. multivorans was isolated from respiratory sources in 18 cases (78%). We observed medication preparation items, gloves, and patient care items stored within sink splash zones in ICU medication preparation rooms and patient rooms. Nonsterile water and ice were used for bed baths, swallow evaluations, and ice packs. B. multivorans was cultured from ice and water dispensed from an 11-year-old ice machine in the ICU at hospital A in March 2022 but no other water sources. Additional testing in July 2022 yielded B. multivorans from ice and a drain pan from a new ice machine in the same ICU location at hospital A. All products were negative. Clinical and environmental isolates were the same strain by RAPD and Rep-PCR. Conclusions: The use of nonsterile water and ice from a contaminated ice machine contributed to this outbreak. Water-related fixtures can serve as reservoirs for Burkholderia, posing infection risk to hospitalized and immunocompromised patients. During outbreaks of water-related organisms, such as B. multivorans , nonsterile water and ice use should be investigated as potential sources of transmission and other options should be considered, especially for critically ill patients.Disclosures: None

What Is Going on in Indoor Air Quality of a University Hospital in Northern Cyprus?

There are two main purposes of microbial monitoring of the inanimate hospital environment. One of them is to monitor hygiene standards, and the second is to determine the presence of nosocomial pathogens. This study was aimed to investigate the indoor environment of the different departments of a university hospital. The prospective study was conducted in a university hospital, a teaching hospital with 143 beds and 30 ICU beds, and a hospital with 6 different wards in Northern Cyprus. Active air sampling was done by using an air IDEAL 3P device. Air samples were taken at 38 points defined before in different parts of the hospital. Our results showed a low level of microorganisms' numbers in microbial airborne communities in a university hospital. Moreover, our results indicated that the temperature of the hospital's indoor environment is not significantly related to the airborne microbial community. On the other hand, our results indicate that the Aspergillus species were mostly isolated in the drug preparation room. The studies have shown that one of the causes of hospital infections is the microorganisms entering the airborne microbial communities. In this case, epidemiology and pathogenesis of airborne microbial communities should be understood.

Molecular Epidemiological Investigation and Management of Outbreak Caused by Carbapenem-Resistant Acinetobacter baumannii in a Neonatal Intensive Care Unit.

The present study describes an epidemiological investigation into a carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak, which had occurred in a neonatal intensive care unit (NICU), and the subsequent strengthening of infection control interventions. Upon the onset of the outbreak, existing infection control interventions were reviewed, and a set of containment measures were instituted. All CRAB isolates were characterized in terms of antimicrobial susceptibility testing and their genetic relatedness. The investigation process identified gaps within the NICU's existing infection control measures, which had likely resulted in the outbreak. CRAB was isolated from nine preterm infants: five colonized and four infected. All five colonized patients were discharged well. However, three out of four of the infected infants died. Outbreak investigation and genomic subtyping of environmental swabs revealed that mini syringe drivers shared between patients and a sink in the milk preparation room had served as CRAB reservoirs with possible transmission via the hands of healthcare workers. Implementation of immediate actions such as reinforcement of hand hygiene practices, intensified environmental cleaning, geographical cohorting, reviewing of milk handling practices and sink management protocol had resulted in no further CRAB isolation. The CRAB outbreak in the NICU underlines the importance of consistent compliance with infection-control interventions. Integration of epidemiological and microbiological data, together with comprehensive preventive measures, successfully brought the outbreak to a halt.

The Effect of Hand Massage on Reducing the Anxiety Level of Pre-Surgery Clients in Tangerang City Regional Public Hospital

Surgical procedures are important events in human life which complex and stressful. When hearing the word surgery, patients face situations that can cause fear, worry, helplessness, and anxiety. Surgical procedures may cause psychological and physical problems in patients undergoing surgery. Waiting in the preparation room is the most worrying moment for a patient undergoing a surgical procedure. The patient is faced with a situation where the patient is under a high level of anxiety. This study aimed to determine the effect of hand massage on reducing anxiety levels in pre-surgery clients at Tangerang City Regional Public Hospital. This study used a quantitative design with a quasi-experimental approach; a study provides treatment (intervention) and measures the effects of treatment. The approach technique was a one-group pre-test and post-test. The total number of study participants was 18 people. The study utilized a simple random sampling. The results showed that giving hand massage interventions could reduce anxiety levels by 8.2, from 58.3 to 50.1 after a hand massage. The results of the T-test obtained a p-value of 0.001. It was concluded that there was a significant difference between the level of anxiety before and after giving the hand massage intervention. It is recommended to conduct further research with a different approach.

Identification of Sensitive Raw Materials at A Milk Preparation Room of A Neonatal Intensive Care Unit in the Canselor Tuanku Muhriz Hospital

The implementation of a Hazard Analysis and Critical Control Point (HACCP) system in infant milk preparation can prevent and reduce the risk of bacterial contamination in infant feedings. Therefore, it is very important to determine the sensitive raw materials (SRM) in a milk room of a neonatal intensive care unit (NICU) to prevent contamination that can affect the safety of milk feeding. This study was conducted to identify the SRM at the milk preparation room of a NICU in the Canselor Tuanku Muhriz Hospital, Cheras, Kuala Lumpur, Malaysia. SRM were identified via HACCP system decision tree by the Malaysian Standard (MS1480:2007).. The results showed that donor expressed breast milk (DEBM), expressed breast milk at home (EBMH), freshly expressed breast milk (FEBM) and powdered infant formula (PIF) were identified as SRM. Expressed breast milk (DEBM, EBMH, FEBM) were known as non-sterile milk which were able to transmit pathogenic microorganisms such as Klebsiella pneumoniae and Pseudomonas aeruginosa derived from the mother or donor. PIF is also not sterile that are associated with Cronobacter sakazakii and Salmonella infections causing serious illnesses among premature and infants. Ready to feed milk (RTF) is classified as non-sensitive material as it is sterile, free from bacterial contamination and safe for high-risk infant’s feeding compare to PIF. Preventive measures were applied to control the significant hazards in all identified SRM to ensure the final product (milk) is safe for consumption.

Computational fluid dynamics simulation of cryogenic safety analysis in an liquefied natural gas powered ship during liquefied natural gas leakage

LNG is considered a promising alternative fuel for the marine industry with the increasingly strict environmental requirements while the safety problems caused by LNG leakage accidents need to be concerned and analyzed. In this article, the cryogenic safety analysis of the fuel gas preparation room in an LNG-powered ship during LNG leakage accidents was performed by CFD simulations. The simulation results showed as follows: the range of cryogenic region in the fuel gas preparation room was related to flow field direction during LNG leakage; The surface temperature of equipment dropped to some extent during LNG leakage accidents. The temperature drop was less than 15°C, which was confirmed to be a safe temperature range in engineering; In addition, for safety operation analysis, the NG distribution situation of dangerous regions with explosive limit was also obtained.

Investigation on the Epidemiology and Pathogenesis Characteristics of <i>Staphylococcus pseudintermedius</i>-Associated Veterinary Hospital Infections

A retrospective analysis of the diagnostic laboratory submissions from 2016 to 2020 was performed to assess the antibiotic resistance of Staphylococcus pseudintermedius and determine locations in the hospital which might be acting as environmental source(s). Previous studies have identified a significant increase in infections with S. pseudintermedius. Samples were taken from the hospital environment by swabbing areas in the intensive care unit and anesthesia preparation room and bacterial species identified. Isolates obtained from patients were then examined regarding the ability to form biofilm, an important phenotype on hospital-related infection. In addition, veterinary hospital associated strains of S. pseudintermedius were used to determine the bactericidal effect of the used disinfectant, applying the hospital current protocol, by comparing the efficacy against S. pseudintermediius and a strain of Staphylococcus aureus from a dog. The isolates identified were resistant to commonly used antibiotics such as enrofloxacin and cephalosporins, and 45% percent of those were methicillin resistant. The environmental survey in the hospital identified S. pseudintermedius in the pre-anesthesia area, although the isolate was killed by the current used disinfection protocol. A few disease associated bacteria were evaluated for biofilm formation in comparison to a dog isolate of Staphylococcus aureus, demonstrating strong ability to form biofilms.

Chemotherapy supply chain management, safe-handling and disposal in Ethiopia: the case of Tikur Anbessa specialized hospital

Optimal chemotherapy management is substandard in low and middle-income countries. We aimed to identify major gaps to design interventional strategies for improved chemotherapy management at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. This study was conducted using an observational checklist, open-ended questions, record review, and key informant interviews of department heads and focal persons at TASH. Findings were categorized into specific themes that developed. Chemotherapy represented 60.2% of the hospital medication budget. Drug utilization was quantified via monthly consumption documentation and forecasting. However, unreliable data resulted in frequent stockouts (unavailability of the item when it is needed) of chemotherapy with only 67.8% availability. Thirteen healthcare personnel (9 nurses, 2 pharmacists and 2 hospital cleaners) were interviewed: all clinical staff but neither of hospital cleaners believed that they were at risk of hazardous agents. Challenges identified included inadequate and frequent stockouts (unavailability of the item when it is needed) of personal protective equipment, lack of standardized guidelines for chemotherapy handling, admixture, and disposal, lack of designated preparation rooms, and lack of training. All nine nurses handled chemotherapy admixtures despite only two nurses previously receiving in-service training. Most of the participants had never witnessed the disposal of anticancer drugs. Prompted by the results of this study, a dialogue was initiated among members of TASH, the American Cancer Society and the University of North Carolina to implement action-oriented projects to address the gaps identified at TASH. These gaps directly and indirectly affect care and treatment outcomes of patients at a large cancer center. Collaborations with well-resourced centers are potential models for improving chemotherapy management.

Wear and Color Stability of Preheated Bulk-fill and Conventional Resin Composites.

Bulk-fill resin composite is commonly used in direct restorations. It is recommended that the high-viscosity version of these materials be preheated to improve flowability and adaptability. It is unknown what effects preheating (PH) might have on the wear resistance and color stability of these resin composites. This study compared the wear and color stability of high-viscosity bulk-fill and conventional resin composites with and without PH, using the CIEDE2000 formula. Thirty-two disc-shaped specimens (n=16, 10×3 mm) were prepared with Filtek One Bulk Fill Restorative (FOBFR; 3M ESPE) and Filtek Supreme Ultra (FSU, 3M ESPE) to determine wear. Each group was divided into subgroups based on preparation conditions, that is, PH and room temperature (RT) (n=8). Thermomechanical fatigue was applied to specimens, and volumetric material loss was calculated using a laser scanner (LAS-20, SD Mechatronik, Feldkirchen-Westerham, Germany) and three-dimensional imaging software (Geomagic, 3D Systems, Rock Hill, SC, USA). An additional 124 disc-shaped specimens (n=64, 10×1 mm) were prepared with FOBFR and FSU, and subgroups were formed based on preparation conditions (PH and RT, n=32). Specimens were aged for 14 days in coffee, grape juice, distilled water, and thermocycling (20,000 cycles, 5°C-55°C). To determine color change, the lightness (L), chroma (C), and hue (H) values were measured at baseline and after 14 days using the CIEDE2000 formula. All data were statistically analyzed, and a 95% significance level was set. In both the PH and RT groups, FSU exhibited greater wear than FOBFR (p<0.05). Both materials were subjected to increased wear as a result of PH. After aging, a significant difference in color change was observed (p<0.05) when controlling for time and resin composite type, except for deionized water and thermocycling (p>0.05). PH had no effect on the color stability of the resin composite at any time (p<0.05). The high-viscosity bulk-fill resin composite displayed superior wear resistance and similar color stability compared with its conventional counterpart. PH resin composite may increase its susceptibility to wear and has no effect on its color stability.

Yellow Sweet Potato Nastar(Ipomoea Batatas L.) And The Addition Of Fat Type On Chemical Characteristics of Organoleptic Test

Dependence on flour needs to be reduced by utilizing local food ingredients that can enrich the active compounds in nastar cakes. The distinctive taste of yellow yam flour provides an innovative new taste of nastar with a combination of sweetness from chocolate jam. The comparison between yellow sweet potato flour and cornstarch in nastar cakes will provide a new taste and increase the nutritional content and as a natural coloring agent in the manufacture of pastries. The proportion of use of cornstarch in sweet potato nastars is used as a softener in pastries and cakes due to the nature of this cornstarch which can bind water to the dough so that the texture is softer and denser. This study aims to determine the sensory properties of nastar cookies with variations of yellow sweet potato flour and cornstarch with the addition of fat types so as to get the right formula. Organoleptic tests carried out included color, taste and taste. Test respondents used a sensory preference test (hedonic rating) with 30 panelists. By using the hedonic test and the results are expressed in numbers 1-5. 1 = strongly dislike, 2 = dislike, 3 = neutral, 4 = like, 5 = very much like. The hedonic test is the most widely used test to measure the level of liking for the product where the panelists express personal impressions about good or bad. conducting organoleptic tests, namely panelists, a laboratory consisting of a preparation room, waiting room and discussion room. The way to do the orgnoleptic test is that the presenter prepares the sample in the preparation room, for the panelists to be in the discussion room to taste the sample that has been prepared by the presenter. Panelists fill out the forum that has been prepared by the presenter in the discussion room. The foam consists of color, taste, and aroma tests using hedonic tests and the results are expressed in numbers 1-5.

A study on the design of a practical arts laboratory for elementary level technology education in Korea

This study was conducted to confirm the specifications of the laboratory and the list of practice tools for technology education in elementary schools in Korea. For effective technology education, standardized laboratory specifications and a list of practice tools are needed. However, there were no standardized laboratory specifications and a list of practice tools for elementary school students in Korea, so there were many difficulties in practicing related to technology education at the elementary level. In particular, elementary-level technology education is combined with home economic and agricultural education within the subject of practical art subjects in Korea. Therefore, the laboratory should have a complex function so that it is not only for technology education but also to enable practice in other fields. The name of the lab is “The Practical Arts Laboratory” in elementary schools in Korea. The study design and method to achieve the study purpose are as follows. First, in the theoretical analysis stage, the concept of the laboratory and considerations for designing the laboratory were confirmed through the review of previous studies. Next, a list of practice tools was derived using the big data analysis method. Then, in the actual design stage, the practical arts laboratory was designed and an expert feasibility study was conducted. The results of the study are as follows. First, the minimum area of the practical arts laboratory is 13,600mm×12,450mm, which is twice the size of a general classroom. In addition to the practical arts laboratory, a preparation room for storing practice tools is also required. The minimum area of the preparation room is 12,450mm×3,500mm, which is 1/4 the size of practical arts laboratory. Second, the practice table in the practical arts laboratory was designed as a comprehensive practice table that allows various types of practice, and the area was designed to be 600mm×1,200mm in consideration of the Korean work area. Third, the number of practice tables was set to six considering the size of the practical arts laboratory and the number of people per class in elementary schools in Korea. As of 2018, the number of people per class at an elementary school in Korea was 23.1, so four people were set to use one practice table. Practice is a key element in technology education. Thus, it will be said that the practical arts laboratory plays a very important role in Korea’s elementary level technology education as an environmental background that makes the practice effective. For this reason, the standard specifications of the practical arts laboratory and the list of practice tools presented in this study are expected to contribute to the development of elementary-level technology education in Korea. Also, our results can be a reference for other countries in the world that have a similar situation to Korea.

Assessment of formaldehyde exposures under contemporary embalming conditions in U.S. funeral homes

ABSTRACT The funeral service profession has used formaldehyde-containing embalming solutions for preparation of decedents since the early 1900s. The available literature regarding funeral director exposure to formaldehyde largely consists of data collected prior to 2000, with most studies reporting task-length exposure concentrations rather than full-shift time-weighted average concentrations. As formaldehyde undergoes review in the U.S. Environmental Protection Agency Toxic Substances Control Act (TSCA) risk evaluation process, accurately characterizing long-term exposure potential among this profession is critical. This study presents passive badge sampling and air change rate measurement results conducted at 13 funeral home locations across the United States. Full-shift (approximately 8-hour) samples were collected on one embalmer per day in each funeral home and on one occupational non-user (ONU), e.g., a receptionist. Additionally, task-length samples were collected during each embalming that occurred during the shift, were one to occur. Full-shift concentrations ranged from 0.007 to 1.1 ppm and 0.007 to 0.042 ppm for embalmers and ONUs, respectively. Task-length formaldehyde concentrations ranged from 0.058 to 1.4 ppm, with the average embalming taking 72.8 minutes to complete. Air change rates in the preparation rooms ranged from 2.8 to 28.3 air changes per hour; however, no correlation between task-length formaldehyde concentrations and air change rate was observed. Following empirical data collection, a Monte Carlo analysis of estimated annual 8-hour time-weighted average (TWA) exposure was conducted to determine the potential exposure distribution for embalmers employed at private funeral homes. Inputs to the simulation were derived from responses to a National Funeral Directors Association survey and from empirical measurements collected during the study. With respect to the reconstructed 8-hour TWAs, the median 8-hour TWA was 0.037 ppm, with 93.6% of the predicted concentrations below 0.1 ppm. This study provides a robust characterization of contemporary formaldehyde exposures in the funeral service profession. Further, it provides a strategy for interpreting the results along with surveyed responses regarding embalming frequency to better inform risks associated with formaldehyde exposure in this profession.

Operationalization of an Expanded Anteroom in a COVID-19-Dedicated Hospital in South Korea.

The concentration of patients in a few facilities burdens healthcare providers and the healthcare system. This study examined the operations of an extended anteroom in a COVID-19–dedicated hospital. It presents issues to consider in the deployment and operation of an extended anteroom through discussions by expert working groups. The subjects covered included efficient space, staffing, equipment management, and education. The process involved wearing personal protective equipment (personal protective equipment; in this case, Level D), and if necessary, wearing additional powered air purification respirators (PAPR), after moving from the preparation room to the dressing room, and when entering the hospital through the entrance passage. When leaving the hospital, personnel used a mandatory exit-only passage. In the dressing room, they undressed, and then went outside. The efficient spatial composition of the anteroom facilitated entry and exit, as well as the separation of contaminated and non-contaminated areas using colors and lines. As COVID-19 spread rapidly in the community, COVID-19–dedicated hospitals were established highly quickly. Therefore, there exists a limitation because sufficient discussion with external experts has not been made. In the future, the development of an operating manual for dedicated infectious disease hospitals and continued research into the improvement of care is needed. This study indicated the need to develop educational programs and use educational simulations, to address regionally spread infectious diseases.

Patients’ Operative Care Knowledge and Desire for Information About Surgery and Anesthesia

Introduction: Good communication between patients and health professionals and sharing of information on operative procedures form the basis of informed consent. The objective of the study was to assess our patients’ information on the operative procedures and their desire for information about surgery and anesthesia. Methods: This was a descriptive cross-sectional study done in one of the academic institutes of Nepal. The sample size calculated was 422. A simple random sampling by proportionate method was used. Patients between 18 to 80 yrs. scheduled for elective surgeries were included in the study. The questionnaires were read by anesthesiologist to the participants after preanesthetic check-up just before scheduled operation in the preparation room. Patients were requested to complete a 100 mm visual analogue scale by marking a cross to indicate level of anxiety on a spectrum of 'not anxious ' to 'extremely anxious'. Results: The final number of participants were 404. About 21.53 % of the patients did not know about the type of operation that they were about to undergo and 19.8 % of the patients were unaware whether they would be put into unconscious state or not. More than half did not know about duration of surgical procedure (61.88%), time of resuming daily activities after surgery (60.64%), duration of stay in hospital (48.76%), pain after surgery (47.77%). There was positive correlation between the information and level of education (p&lt;0.001) and patients with past history of surgeries (p=0.001). Conclusion: The patients lacked information on operative care especially regarding duration of surgical procedure, duration of stay in hospital and time required for resuming daily activities.

THE EFFECTIVENESS OF USING THE LABORATORY IN LEARNING SCIENCE

The science that studies nature and its processes are called Science. When learning about Science, the laboratory has an essential role in growing students' experimentation abilities and increasing students' enthusiasm for learning. This study aims to describe and determine the effectiveness of the use of laboratories in science learning at SMPN 2 Lumajang. This study uses an approach with the interview method. This research was carried out at SMPN 2 Lumajang, which involved subject science teachers at the SMPN. The results showed that the science laboratory at SMPN 2 Lumajang had two rooms: a laboratory room and a storage room. Judging from the aspect of the laboratory space, the science laboratory of SMPN 2 Lumajang still needs to be improved a bit, such as a space to store tools and materials, and there is no preparation room to make preparations before the practicum begins. The existing facilities and infrastructure influence the effectiveness of the use of laboratories in the learning process. With complete facilities and infrastructure, student learning activities in observations will run smoothly.

Retrospective Assessment of the Impact of Primary Language Video Instructions on Image Quality of Abdominal MRI.

To assess the impact of instructional videos in patients' primary language on abdominal MR image quality for whom English is a second language (ESL). Twenty-nine ESL patients viewed Spanish or Mandarin Chinese instructional videos (approximately 2.5 min in duration) in the preparation room before abdominal MRI (ESL-video group). Comparison groups included 50 ESL patients who underwent MRI before video implementation (ESL-no video group) and 81 English-speaking patients who were matched for age, sex, magnet strength, and history of prior MRI with patients in the first two groups. Three radiologists independently assessed respiratory motion and image quality on turbo spin-echo T2-weighted images (T2WI) and postcontrast T1-weighted images (T1WI) using 1 to 5 Likert scales. Groups were compared using Kruskal-Wallis tests as well as generalized estimating equations (GEEs) to adjust for possible confounders. For T2WI respiratory motion and T2WI overall image quality, Likert scores of the ESL-no video group (mean score across readers of 2.6 ± 0.1 and 2.6 ± 0.1) were lower (all P < .001) compared with English-speaking (3.3 ± 0.2 and 3.3 ± 0.1) and ESL-video (3.2 ± 0.1 and 3.0 ± 0.2) groups. In the GEE model, mean T2WI respiratory motion (both adjusted P < .001) and T2WI overall quality (adjusted P= .03 and .11) were higher in English and ESL-video groups compared with ESL-no video group. For T1WI respiratory motion and T1WI overall image quality, Likert scores were not different between groups (P > .05), including in the GEE model (adjusted P > .05). Providing ESL patients with an instructional video in their primary language before abdominal MRI is an effective intervention to improve imaging quality.

A critical Review of Dhoopan Karma in Ayurveda and Dhoopana of an Ayurvedic Herbomineral formulation Yavasarshapadi churna in context of Sterilization.

Dhoopana Karma is classical remedy mentioned in various Ayurvedic scriptures to maintain disease free and hygienic environment in the world. As per Ayurvedic scriptures Dhoopana is indicated for Rakshoghna Karma which means killing of disease producing microorganisms. Hence, it plays key role in prevention and cure of various infectious diseases.A similar process called fumigation is one of best and fastest method to maintain asepsis, antisepsis in wards and operation theatres of hospitals.Additionally, this study comprises critical literary review of herbomineral formulation named Yavasarshapadi Choorna which is indicated in form of incense for Dhoopana karma. It is indicated in Ayurvedic scripture Charaka Samhita in chapter Jatisutriya Sharir Adhyaya of Sharir Sthana. It was reviewed in context of sterilization activity to maintain asepsis and antisepsis. Specifically, it is indicated for fumigation of cloths and belongings of post-natal period of Women and that of the New born, Drug preparation room, New born care room, Surgical Procedure room modern surgery, traditional operation theatre sterilization was done by formalin gas fumigation over many decades which is found to have carcinogenic effect over human lives. Ayurvedic modality named Dhoopana was undertaken in current study as it is a safe and healthy alternative for sterilization.It overcomes harmful effects caused by modern sterilization method i.e. Formalin gas fumigation which is need of an hour. The Analytical study of antimicrobial and antifungal effect of various Ayurvedic Dhoopana Dravyas is the need of the hour along with preclinical and clinical study to verify Sterilization activity of various Ayurvedic Dhoopana Dravyas.

Using Six Sigma DMAIC for Lean project management in education: a case study in a German kindergarten

The purpose of this study was to investigate how Lean can be applied in an educational environment to improve operational processes. The application of the Six Sigma methodology blended and supported by the application of various Lean tools is demonstrated in a case study of a kindergarten. Multiple tools, such as: the fishbone diagram; A3 reporting; ‘5 Why’s’; process mapping; waste analysis; and 5S amongst others led to a reorganisation of the preparation room. This produced overall reductions of 82.65% in excess motion, 75.49% in excess transport, and 60.66% in excess inventory. Furthermore, more than 45 min of preparation time were saved due to the reduction of non-value-added time. The challenges and barriers, as well as, areas of future applicability were also investigated. This case study provides practitioners valuable insights into the applicability of the Six Sigma framework for Lean implementation in a primary education setting. Further, insights regarding the future applicability and benefits in the respective field are provided. Finally, the challenges and barriers, as well as, its general future applicability are discussed.

Organ donation after euthanasia starting at home in a patient with multiple system atrophy

BackgroundA patient who fulfils the due diligence requirements for euthanasia, and is medically suitable, is able to donate his organs after euthanasia in Belgium, the Netherlands and Canada. Since 2012, more than 70 patients have undergone this combined procedure in the Netherlands. Even though all patients who undergo euthanasia are suffering hopelessly and unbearably, some of these patients are nevertheless willing to help others in need of an organ.Organ donation after euthanasia is a so-called donation after circulatory death (DCD), Maastricht category III procedure, which takes place following cardiac arrest, comparable to donation after withdrawal of life sustaining therapy in critically ill patients. To minimize the period of organ ischemia, the patient is transported to the operating room immediately after the legally mandated no-touch period of 5 min following circulatory arrest. This means that the organ donation procedure following euthanasia must take place in the hospital, which appears to be insurmountable to many patients who are willing to donate, since they already spent a lot of time in the hospital.Case presentationThis article describes the procedure of organ donation after euthanasia starting at home (ODAEH) following anesthesia in a former health care professional suffering from multiple system atrophy. This case is unique for at least two reasons. He spent his last conscious hours surrounded by his family at home, after which he underwent general anaesthesia and was intubated, before being transported to the hospital for euthanasia and organ donation. In addition, the patient explicitly requested the euthanasia to be performed in the preparation room, next to the operating room, in order to limit the period of organ ischemia due to transport time from the intensive care unit to the operating room. The medical, legal and ethical considerations related to this illustrative case are subsequently discussed.ConclusionsOrgan donation after euthanasia is a pure act of altruism. This combined procedure can also be performed after the patient has been anesthetized at home and during transportation to the hospital.

Design and preliminary experience of a transportable equine operating theatre.

Equine surgical facilities are not always available, even in situations where high-value horses are involved in relatively high-risk activities. To develop a self-contained equine surgical unit that can be relocated and transported by road. Proof of concept. A modular operating suite for horses, which included a theatre, scrub room, instrument preparation and storage room, and an anaesthetic induction/recovery box: Transportable Equine Operating Theatre (TEOT) was designed, constructed and tested. A second, larger unit was then built following the same design criteria. Both units were based on modifications of standard 6.06×2.35m (20×8ft), steel shipping containers that were fitted out to provide anaesthetic and surgical facilities in a functional and safe working environment. The two TEOTs consisted of either two or three containers that had selected sections of their sides removed so that they could be joined together to create a single large internal space. This space was subdivided to create separate working areas. A dedicated anaesthetic induction/recovery box was fabricated from a modular steel frame that could be disassembled for transport. The component parts could be loaded onto the bed of a standard lorry for road transport. The unit was designed to incorporate equipment that is found in any high-quality equine operating theatre. Surgical procedures on adult Thoroughbred horses have been successfully completed in both units. The two units have had minimal use to date, and there is little data on their performance. The equipment described here is a way to provide equine surgical facilities that can be assembled and disassembled to allow their relocation to different sites.